Claims Examiner I – Medical Only Adjuster Experience

This is a fully remote position, open to applicants in Texas.

📋 Description

• Under close supervision, oversees all facets of medical-only claims management from start to finish, adhering to established authority and guidelines.

• Effectively handles a caseload of 150 to 180 workers’ compensation files.

• Initiates and performs claims investigations promptly.

• Assesses the compensability of claims and administers benefits according to state law and established Company protocols.

• Oversees medical treatment and medical billing, authorizing as necessary.

• Engages with claimants, providers, and vendors concerning claims-related issues.

• Calculates and establishes reserves in line with Company guidelines.

• Maintains a diary system for case reviews and documentation to reflect the status and ongoing work on the file.

• Provides relevant information to the client promptly to facilitate efficient claims resolution, including any injury trends or safety-related concerns.

• Involves TRISTAR loss control staff when appropriate.

• Complies with all Company policies and procedures.

• Participates in file reviews as necessary.

⛳️ Requirements

• At least one (1) year of relevant experience, or a suitable combination of education and experience.

• Technical understanding of statutory regulations and medical terminology.

• Strong analytical skills.

• Excellent written and verbal communication abilities, including the capacity to convey technical information to claimants, clients, and staff.

• Capability to interact with individuals at all levels within the business environment.

• Proficiency in Word and Excel (preferred).

🏝️ Benefits

• Medical, Dental, Vision Insurance

• Life and Disability Insurance

• 401(k) Plan

• Paid Holidays

• Paid Time Off

• Referral bonus